Objective:This study aimed to evaluate the therapeutic effect of intratympanic injection of ganglioside in patients with refractory sudden deafness. Methods:A total of 120 patients with sudden deafness, aged 18-65 years, whose onset was within 11-42 days, failed to respond to conventional treatment, and had an average hearing threshold（500-4 000 Hz）>60 dB were selected. They were prospectively and randomly divided into a control group of 61 cases and an experimental group of 59 cases. The control group was treated according to the recommended protocol of the Chinese Medical Association（postauricular injection of methylprednisolone）, while the experimental group was treated with intratympanic injection of monosialotetrahexosylganglioside sodium+postauricular injection of methylprednisolone. Both groups were simultaneously administered oral ginkgo biloba extract and citicoline tablets. Hearing was re-examined two weeks after the completion of treatment, and the therapeutic effects of the two different treatment methods were compared and analyzed. Results:The effective rate was 29.51% in the control group and 54.24% in the experimental group（P<0.01）. The average hearing threshold improved by 11.57 dB HL in the control group and 22.50 dB HL in the experimental group（P<0.05）. Conclusion:The combination of postauricular injection of methylprednisolone and intratympanic injection of ganglioside is more effective than postauricular injection of methylprednisolone alone in the treatment of refractory sudden deafness. The earlier the treatment, the better the therapeutic effect.
Humans ; Middle Aged ; Hearing Loss, Sudden/drug therapy* ; Adult ; Prospective Studies ; Young Adult ; Aged ; Adolescent ; Male ; Female ; Injection, Intratympanic ; Gangliosides/administration & dosage* ; Methylprednisolone/therapeutic use* ; Treatment Outcome

Objective:To investigate the long-term efficacy, safety and prognostic factors of intraoperative radiotherapy (IORT) for narrow-margin (resection margin < 1 cm) hepatectomy in patients with hepatocellular carcinoma (HCC) during radical surgery.Methods:A retrospective cohort study was conducted. The data of primary HCC patients undergoing radical surgery and narrow-margin hepatectomy IORT in the Cancer Hospital of the Chinese Academy of Medical Sciences from November 2009 to February 2019 were collected. IORT applied 6 MeV or 9 MeV electron beams and a single irradiation was given to the margin. Kaplan-Meier method was used for the overall survival (OS) and disease-free survival (DFS) analysis; log-rank test was used for survival comparison among subgroups. The recurrence patterns and adverse reactions were recorded. Univariate and multivariate Cox proportional hazards models were used to analyze the factors influencing the OS and DFS.Results:A total of 64 patients were enrolled, with the median age [ M ( Q1, Q3)] of 57 years (49, 63) years. All patients included 55 males (85.9%) and 9 females (14.1%). The median dose of IORT was 15 Gy (range: 12-17 Gy). The median follow-up time was 83.3 (64.4, 91.9) months. The 1-year, 3-year, 5-year, 7-year, 10-year OS rates were 90.4%, 80.6%, 75.5%, 71.4% and 47.6%, respectively; the 1-year, 3-year, 5-year, 7-year,10-year DFS rates were 77.8%, 68.1%, 59.6%, 57.6% and 38.4%, respectively. Univariate Cox regression analysis indicated that preoperative serum alpha-fetoprotein (AFP) > 400 ng/ml was an independent risk factor for poor OS (> 400 ng/ml vs. ≤ 400 ng/ml: HR = 6.57, 95% CI: 2.16-19.96, P < 0.001), while not the independent influencing factor of poor DFS ( HR = 1.71, 95% CI: 0.65-4.52, P = 0.277). The age ≤ 60 years or not, gender, viral hepatitis or not, American Joint Committee on Cancer stage, tumor diameter (> 5 cm or not), tumor number, degree of tumor differentiation, microvascular invasion or not, microsatellite nodules or not, anatomical liver resection or not, and the dose of IORT ≤15 Gy or not were not the independent influencing factors of poor OS and DFS (all P > 0.05). Kaplan-Meier method analysis showed that patients with preoperative serum AFP ≤ 400 ng/ml (48 cases) had better OS compared with those with preoperative serum AFP>400 ng/ml (16 cases) (5-year OS rate: 84.8% vs. 44.9%; 7-year OS rate: 79.9% vs.37.4%), and the difference was statistically significant ( P = 0.002). There was no statistically significant difference in the DFS between the 2 groups ( P = 0.134). During the follow-up, 28 patients (43.8%) relapsed, including 17 cases (26.6%) of early recurrence and 11 cases (17.2%) of late recurrence. No marginal recurrence was observed. There were 22 cases (34.4%) of intrahepatic recurrence alone, 2 cases (3.1%) of extrahepatic recurrence and 4 cases (6.3%) of stimutaneous recurrence inside and outside the liver. The 1-, 3-, 5- and 7-year cumulative recurrence rates inside the liver were 19.0%, 27.2%, 37.4% and 39.3% respectively, and the cumulative recurrence rates outside the liver were 6.4%, 8.0%, 9.6% and 9.6% respectively. There were no adverse reactions above grade 3 in the entire group. There were no surgery-related deaths within 30 d after the operation, and no radiation-induced liver disease occurred. Conclusions:Narrow-margin IORT helps HCC patients receiving hepatectomy to achieve favorable long-term survival and adverse reactions are tolerable. It can be used as a safe and effective adjuvant therapy alternative.

Objective:To investigate the additional prognostic value of coronary CT angiography (CCTA)-based flow reserve fraction (CT-FFR) over semi-quantitative CCTA risk scores in predicting the occurrence of major adverse cardiovascular events (MACE) in type 2 diabetic patients.Methods:A total of 231 patients with type 2 diabetes mellitus who underwent CCTA at Lanzhou University from May 2020 to April 2021 were retrospectively enrolled. Clinical baseline data were collected, and patients were divided into a MACE-positive group (20 cases) and a MACE-negative group (211 cases) based on follow-up results. The CCTA images of all patients were analyzed by semi-quantitative CCTA risk score, which included coronary artery disease reporting and data system classification, segment involvement score, segmental stenosis score, Leaman score, and Leiden score. CT-FFR measurements of CCTA data of all patients were performed using Coronary Analysis software. t-test, U-test, and χ2 test were used to compare baseline parameters between MACE-positive and MACE-negative groups. The Cox proportional hazards regression model was used to analyze the relationship between semi-quantitative CCTA risk score and CT-FFR with the occurrence of MACE, and the area under the curve (AUC) of the receiver operating characteristic (ROC) was used to calculate the efficacy of the prediction model established by the semi-quantitative CCTA risk score combined with CT-FFR. Results:There was no statistically significant difference in baseline data between patients in the MACE-positive and MACE-negative groups ( P>0.05), and there were significant differences in semi-quantitative CCTA risk scores and CT-FFR ( P<0.05). Multivariate Cox proportional risk regression analysis of CT-FFR≤0.80 ( HR=3.860, 95% CI 1.477-10.087, P=0.006) and Leaman score≥5 ( HR=5.210, 95% CI 1.136-23.908, P=0.029) were the best and independent predictors for the occurrence of MACE events. The combined CT-FFR and Leaman score prediction model (AUC=0.791, 95% CI 0.733-0.842, P<0.001) was a better predictor of MACE than CT-FFR alone (AUC=0.718, 95% CI 0.656-0.775, P<0.001) and Leaman score alone (AUC=0.711, 95% CI 0.648-0.768, P<0.001) both had better predictive efficacy ( Z=2.62, 1.98, P=0.009, 0.047). Conclusion:CT-FFR independently predict the occurrence of MACE in patients with type 2 diabetes mellitus and significantly improve the predictive capacity of semi-quantitative CCTA risk score for MACE.

Objective: To screen the risk factors of cesarean scar diverticula ( CSD) after cesarean section and to construct a risk prediction model． Methods: 491 cases of mothers who underwent cesarean section were recruited as the study subjects，and the data from the database of negative ultrasound of mothers who returned to the hospital 12 months after operation were collected，and the dataset was randomly divided into the training set and the test group according to 7 ∶ 3 ; the variables were screened to obtain the risk factors of CSD and the risk prediction model was constructed by the use of least absolute shrinkage and selection operator (LASSO) ; the variables were screened using the LASSO to obtain the characteristic variables，and the characteristic variables were analyzed by multifacto- rial logistic regression analysis，and the nomogram prediction model was constructed by using the R software． Results: A total of 491 cases of sample data were included，including 344 cases in the training set and 147 cases in the test set ; feature variables were screened by LASSO，and ten－fold cross－validation was used．Five variables were finally screened : number of cesarean deliveries，number of years between two cesarean deliveries，24-hour hemorrhage，operation time and uterine position(P＜0. 05) ．The accuracy of the decision analysis curves for inter- nal evaluation and internal validation of the CSD risk prediction model constructed using it was high ; the AUC (95% CI) of the diagnostic model in the training set and the test set were 0. 75 (0. 71－0. 80) and 0. 79 (0. 71 - 0. 87) ，respectively． Conclusion The risk prediction model established using the LASSO cross-validation algo- rithm has good predictive value for the occurrence of postpartum scar diverticula，which deserves clinical attention．

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Objective To develop a nomogram model based on cardiac computed tomography angiography(CCTA)features to evaluate the risk of stroke in patients with persistent atrial fibrillation(PAF).Methods A total of 387 patients with PAF were retrespectively selected.Among them,127 patients had a history of stroke.After collecting patient data,logistic regression analysis was used to screen independent predictors related to stroke outcome,and a nomogram model was constructed.The receiver operating characteristic(ROC)curve was used to analyze and compare the efficacy of the nomogram model and the conventional score for stroke risk assessment.The concordance index(CI)and decision curve analysis(DCA)were used to evaluate the performance of the model.Results Logistic regression analysis showed that age,CHA2DS2-VASc score,smoking history,left atrial appendage(LAA)shape,left atrial volume index(LAVI),LAA fractal dimension(FD)and left atrium(LA)FD were independent predictors of stroke in patients with PAF(P＜0.05).The area under the curve(AUC)of the training set model was 0.886.The AUC of the validation set was 0.763.DCA showed that the nomogram model had better overall net benefits.Conclusion The nomogram model based on CCTA can better evaluate the risk of stroke in patients with PAF,which is helpful for clinicians to make better clinical decisions.

Objective To study the influence of laser diffraction ultrasound parameters on the determination of particle size and particle size distribution of budesonide suspension for inhalation,and explore the rationality of ultrasound parameter settings of the laser diffraction method.Methods The Mastersizer 3000 was set to measure the particle size and particle size distribution of budesonide suspension for inhalation from 6 companies at different ultrasonic times,and the FlowCam was used to test the samples simultaneously.Results The ultrasound parameters have a significant impact on the particle size and particle size distribution of budesonide suspension for inhalation in some companies,and the FlowCam test results show that particles in some samples exhibit aggregation,which can be dispersed by ultrasound and affect the results.Conclusion It is necessary to optimize the ultrasound parameters of laser diffraction to determine the particle size and particle size distribution of suspension for inhalation,and verify the rationality of the ultrasound parameter settings through microscopic techniques.

Objective To study the influence of laser diffraction ultrasound parameters on the determination of particle size and particle size distribution of budesonide suspension for inhalation,and explore the rationality of ultrasound parameter settings of the laser diffraction method.Methods The Mastersizer 3000 was set to measure the particle size and particle size distribution of budesonide suspension for inhalation from 6 companies at different ultrasonic times,and the FlowCam was used to test the samples simultaneously.Results The ultrasound parameters have a significant impact on the particle size and particle size distribution of budesonide suspension for inhalation in some companies,and the FlowCam test results show that particles in some samples exhibit aggregation,which can be dispersed by ultrasound and affect the results.Conclusion It is necessary to optimize the ultrasound parameters of laser diffraction to determine the particle size and particle size distribution of suspension for inhalation,and verify the rationality of the ultrasound parameter settings through microscopic techniques.

OBJECTIVE To explore the significance of pharmaceutical care through the diagnosis and treatment of a patient with exogenous insulin autoimmune syndrome(EIAS),combined with the analysis of literature reports.METHODS Clinical pharmacist participated in the diagnosis and treatment process of one case of EIAS.Based on the characteristics of the patient's condition,the pharmacist provided medication suggestions and formulated pharmaceutical monitoring measures.At the same time,the pharmacist searched for relevant literature on insulin autoimmune syndrome(IAS)and EIAS,extracted data(gender,age,occurrence time,laboratory tests,clinical symptoms,intervention and outcome),and conducted analysis.RESULTS Based on the patient's medication information in the past 3 years,clinical pharmacist determined that the EIAS was likely caused by insulin aspartate 30.The clinician adopted the clinical pharmacist's suggestion to discontinue insulin and switch to oral hypoglycemic drugs.The patient improved after treatment.The literature analysis showed that among the 257 patients with IAS reported,212 cases were caused by drugs;among them,23 cases were caused by lipoic acid,and 56 cases were caused by exogenous insulin.There were no significant differences in age,glycosylated hemoglobin,and body mass index between the two groups.The lowest blood glucose level in the lipoic acid group was significantly lower than that in the exogenous insulin group(P＜0.05).The proportion of females and the proportion of fasting insulin≥1 000 μU/mL were significantly higher in the lipoic acid group than in the exogenous insulin group(P＜0.05).CONCLUSIONS Compared with EIAS,lipoic acid-induced IAS usually causes more severe hypoglycemia,and the fasting insulin level is usually higher than 1 000 μU/mL,which is more common in female patients.The participation of clinical pharmacists in the diagnosis and treatment of EIAS can help improve the diagnosis and treatment level of similar rare diseases and ensure the safety of patients'medication.

Objective To develop a nomogram model based on cardiac computed tomography angiography(CCTA)features to evaluate the risk of stroke in patients with persistent atrial fibrillation(PAF).Methods A total of 387 patients with PAF were retrespectively selected.Among them,127 patients had a history of stroke.After collecting patient data,logistic regression analysis was used to screen independent predictors related to stroke outcome,and a nomogram model was constructed.The receiver operating characteristic(ROC)curve was used to analyze and compare the efficacy of the nomogram model and the conventional score for stroke risk assessment.The concordance index(CI)and decision curve analysis(DCA)were used to evaluate the performance of the model.Results Logistic regression analysis showed that age,CHA2DS2-VASc score,smoking history,left atrial appendage(LAA)shape,left atrial volume index(LAVI),LAA fractal dimension(FD)and left atrium(LA)FD were independent predictors of stroke in patients with PAF(P＜0.05).The area under the curve(AUC)of the training set model was 0.886.The AUC of the validation set was 0.763.DCA showed that the nomogram model had better overall net benefits.Conclusion The nomogram model based on CCTA can better evaluate the risk of stroke in patients with PAF,which is helpful for clinicians to make better clinical decisions.